Continuity of Care, Including Transitions of Care

“Continuity of care” means the provision of continuous care for chronic or acute medical conditions through member transitions between:

Health Care Facilities
Member or community residence
Providers
Services Areas
Managed care health plans
Medicaid fee-for-service (FFS)
Foster care and independent living (including return from foster care placement to community; or change in legal status from foster care to adoption)
Private insurance and managed care coverage

When you transition to our plan from New Hampshire Medicaid, another Medicaid managed care plan, or another type of health insurance coverage you may be able to continue your treatment. When you meet at least one (1) of the conditions below you may continue to get care from your current providers for a limited time, even if your provider is outside the AmeriHealth Caritas New Hampshire network.

In addition to meeting at least one (1) of the conditions below, your current network provider must be in good standing with the plan and New Hampshire Medicaid to continue to provide your treatment.

When one of these clinical circumstances apply to you, you may continue to get care from your treating provider(s) for a limited time	You may continue to get care from your treating provider(s) during this time period	You may continue to get currently prescribed prescription drugs during this time period
You are receiving a prior authorized ongoing course of treatment your current provider at the time of transition	Up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first
You are receiving services with your current provider and you have an acute illness, a condition that is serious enough to require medical care for which a break in treatment could likely result in a reasonable possibility of death or permanent harm	Up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first
You are receiving services that need to continue because you have a chronic illness or condition, a disease or condition that is life threatening, degenerative, or disabling, and requires medical care or treatment over a prolonged period of time	Up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first
You are a child with Special Health Care Needs meaning those who have or are at increased risk of having a serious chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that usually expected for the child’s age and you are in a course of ongoing treatment at the time of transition*	Up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first
You are in your second or third trimester of pregnancy and prefer to continue to receive care through your current provider	Through your pregnancy and up to 60 calendar days after delivery	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first
You desire or require continued services with your current providers because you have a terminal illness, you have a medical prognosis that life expectancy is six (6) months or less	For the remainder of your life with respect to care directly related to the treatment of the terminal illness or its medical effects	For up to 90 calendar days from your enrollment date or until the completion of a medical necessity review by the plan, whichever occurs first

*Including children or infants in foster care; requiring care in a neonatal intensive care unit; diagnosed with neonatal abstinence syndrome (NAS); in high stress social environments/caregiver stress; receiving family centered early supports and services, or participating in Special Medical Services or Partners in Health Services with a serious emotional disturbance, intellectual developmental disability or substance use disorder diagnosis.

When you transfer to another provider or plan, you or your authorized provider may request transfer of your medical records to your new provider(s).

For more information, call Member Services at 1-833-704-1177 (TTY 1-855-534-6730)

Members